WISCONSIN ILLINOIS SENIOR HOUSING INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
WISCONSIN ILLINOIS SENIOR HOUSING INC (EIN 36-4016275)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-09-29
IRS object ID
201112729349300611
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-09-29T11:19:02-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ANDERSON ZURMUEHLEN & CO PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 748AddressLine1
CityBUTTECity
StateMTState
ZIP Code59703ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN364016275EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WISCONSIN ILLINOIS SENIOR HOUSING INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWISCNameControl
Phone2627288167Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line113185 W GREEN MOUNTAIN DRIVEAddressLine1
CityLAKEWOODCity
StateCOState
ZIP Code80228ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRONALD PATTERSONName
TitleSECRETARY-TREASURERTitle
Phone2627288167Phone
Date Signed2011-09-26DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJAMES E WOYName
Phone4067820451Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRONALD PATTERSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line113185 W GREEN MOUNTAIN DRIVEAddressLine1
CityLAKEWOODCity
StateCOState
ZIP Code80228ZIPCode
FieldValueIRS element (for citing)
Gross Receipts31373442GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.WISCONSINILLINOISSENOIRHOUSING.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1994YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionSKILLED NURSING AND ASSISTED LIVING FACILITIES INCLUDING DEVELOPMENTALLY DISABLED FACILITIES.ActivityOrMissionDescription
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees782TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year19999ContributionsGrantsPriorYear
Contributions Grants Current Year39569ContributionsGrantsCurrentYear
Program Service Revenue Prior Year28822103ProgramServiceRevenuePriorYear
Program Service Revenue CY30421464ProgramServiceRevenueCY
Investment Income Prior Year-118610InvestmentIncomePriorYear
Investment Income Current Year228140InvestmentIncomeCurrentYear
Other Revenue Prior Year-1016OtherRevenuePriorYear
Other Revenue Current Year-566OtherRevenueCurrentYear
Total Revenue Prior Year28722476TotalRevenuePriorYear
Total Revenue Current Year30688607TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year15094017SalariesEtcPriorYear
Salaries Etc Current Year15808230SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year13209920OtherExpensePriorYear
Other Expenses Current Year14091510OtherExpensesCurrentYear
Total Expenses Prior Year28303937TotalExpensesPriorYear
Total Expenses Current Year29899740TotalExpensesCurrentYear
Revenues Less Expenses Prior Year418539RevenuesLessExpensesPriorYear
Revenues Less Expenses CY788867RevenuesLessExpensesCY
Total Assets BOY35934260TotalAssetsBOY
Total Assets EOY44420361TotalAssetsEOY
Total Liabilities BOY31444716TotalLiabilitiesBOY
Total Liabilities EOY38977543TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4489544NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY5442818NetAssetsOrFundBalancesEOY
Mission DescriptionTHE PRIMARY PURPOSE IS TO PROVIDE SKILLED NURSING AND ASSISTED LIVING FACILITIES FOR AGED INDIVIDUALS INCLUDING DEVELOPMENTALLY DISABLED FACILITIES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense24955418Expense
Revenue30458762Revenue
DescriptionWISCONSIN ILLINOIS SENIOR HOUSING, INC. OWNS AND OPERATES SKILLED NURSING AND ASSISTED LIVING FACILITIES INCLUDING DEVELOPMENTALLY DISABLED FACILITIES. THE ORGANIZATION CONSISTS OF: FAIR OAKS HEALTH CENTER--46 BED FACILITY, GENEVA LAKE MANOR--60 BED FACILITY, WILD ROSE MANOR--78 BED FACILITY, SHELTERED VILLAGE OF RIPON--50 BED DEVELOPMENTALLY DISABLED FACILITY, HOLTON MANOR--60 BED FACILITY, AND MONTELLO CARE CENTER--46 BED SKILLED NURSING AND 7 BED COMMUNITY BASED RESIDENTIAL FACILITY.Description

Activity2 Activity2

FieldValueIRS element (for citing)
DescriptionWELLINGTON HOMES OF WISCONSIN WAS ORGANIZED TO OPERATE SIX RESIDENTIAL ASSISTED LIVING FACILITIES OF THE BENEFIT OF THE ELDERLY. THE FACILITES HAVE A COMBINED TOTAL OF 160 BEDS. ALL HOMES ARE LOCATED IN THE FOLLOWING WISCONSIN LOCATIONS: FORT ATKINSON, HARTFORD, SEEVENS POINT, WAUSAU, AND WISCONSIN RAPIDS. WELLINGTON HOMES OF WISCONSIN, LLC IS A LIMITED LIABILITY CORPORATION OPERATING AS A DISREGARDED ENTITY. THE FEDERAL ID NUMBER IS 26-0564338. THE SOLE MEMBER OF THE LLC IS WISCONSIN ILLINOIS SENIOR HOUSING, INC. THE ASSISTED LIVING FACILITY OPERATIONS BEGAN IN SEPTEMBER 2007.Description
FieldValueIRS element (for citing)
Total Program Service Expense24955418TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest1ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109630NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees782NumberOfEmployees
Employment Tax Returns Filed0EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1RUTH BABINEAUXBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3039800611TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line113185 W GREEN MOUNTAIN DRIVEAddressLine1
CityLAKEWOODCity
StateCOState
ZIP Code80228ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (7 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
CHARLES W NASON
CHAIRMAN1.00X000
KEN DEVITO
VICE-PRESIDENT1.00X000
DR GLENN HOBERG
MEMBER1.00X000
RONALD PATTERSON
SECRETARY-TREASURER1.00X000
ANDREW KERWIN
MEMBER1.00X000
JILL KRUEGER
MEMBER1.00X000
MARY TELLIS-NAYAK
EXECUTIVE DIRECTOR8.000500000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs50000TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
GENESIS REHAB SERVICES
PO BOX 7247-6524PHILADELPHIAPA191706524THERAPY SERVICES2049600
CARRIAGE QUALITY INC
13185 W GREEN MTN DRIVELAKEWOODCO80228MANAGEMENT COMPANY903120
SYNERTEX
7540 N 19TH STE 200PHOENIXAZ85021THERAPY SERVICES400335
ROESCHEN'S OMNICARE PHARMACY
PO BOX 78083MILWAUKEEWI53278PHARMACY SERVICES375698
FORUM PHARMACY
7440 N FRONTAGE ROADSKOKIEIL60077PHARMACY SERVICES137074
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
All Other Contributions39569AllOtherContributions
Total Contributions39569TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
RESIDENT CARE REVENUE6230001920287619202876
ANCILLIARY REVENUE62300055615775561577
ASSISTED LIVING REVENU62300055000395500039
MISC PATIENT BENEFIT R623000156972156972
FieldValueIRS element (for citing)
Total Program Service Revenue30421464TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column190842TotalRevenueColumn
Exclusion$190,842ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real5761Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real6327Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-566Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-566TotalRevenueColumn
Exclusion-$566ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities715806Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities678508Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities37298Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column37298TotalRevenueColumn
Related Or Exempt Function Income37298RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column30688607TotalRevenueColumn
Related Or Exempt Function Income30458762RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$190,276ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total13642760Total
Program Services13436666ProgramServices
Management And General206094ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total931612Total
Program Services841972ProgramServices
Management And General89640ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1233858Total
Program Services1132914ProgramServices
Management And General100944ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1092550Total
Program Services1092550ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total119935Total
Management And General119935ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total215350Total
Management And General215350ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total19266Total
Management And General19266ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total77378Total
Program Services11752ProgramServices
Management And General65626ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total147550Total
Program Services28856ProgramServices
Management And General118694ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1099960Total
Program Services1022635ProgramServices
Management And General77325ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total100948Total
Program Services19924ProgramServices
Management And General81024ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1797570Total
Program Services15067ProgramServices
Management And General1782503ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1116733Total
Program Services1116733ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total310114Total
Program Services309844ProgramServices
Management And General270ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PURCHASED SERVICES AND30115843011584
SUPPLIES24749922474992
BUSINESS TAXES963046963046
BAD DEBT EXPENSE501253501253
PURCHASED SERVICES AND210860210860

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total832421Total
Program Services439929ProgramServices
Management And General392492ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total29899740Total
Program Services24955418ProgramServices
Management And General4944322ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4350BOY
EOY4850EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1709058BOY
EOY2524154EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3623965BOY
EOY4748839EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY475BOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY58183BOY
EOY52086EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY133794BOY
EOY137086EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis33038401LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec8059356LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY23776886BOY
EOY24979045EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1852459BOY
EOY2084515EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY3504166BOY
EOY7878594EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1270924BOY
EOY2011192EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY35934260BOY
EOY44420361EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3214250BOY
EOY4300194EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY190125BOY
EOY230445EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY25734998BOY
EOY34395002EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY2251355BOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY53988BOY
EOY51902EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY31444716BOY
EOY38977543EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4489544BOY
EOY5442818EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4489544BOY
EOY5442818EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY35934260BOY
EOY44420361EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses788867ReconcilationRevenueExpenses
Reconcilation Other Changes164407ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8661CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9563CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7633CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year19999CurrentTaxYearMinus1Year
Current Tax Year39569CurrentTaxYear
Total85425Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years18087765CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20196628CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24701607CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year28822103CurrentTaxYearMinus1Year
Current Tax Year30421464CurrentTaxYear
Total122229567Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years18096426CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20206191CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24709240CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year28842102CurrentTaxYearMinus1Year
Current Tax Year30461033CurrentTaxYear
Total122314992Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total509122314992PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years229829CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years199562CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years200161CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year83860CurrentTaxYearMinus1Year
Current Tax Year190842CurrentTaxYear
Total904254Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years229829CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years199562CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years200161CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year83860CurrentTaxYearMinus1Year
Current Tax Year190842CurrentTaxYear
Total904254Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years18326255CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20405753CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24909401CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year28925962CurrentTaxYearMinus1Year
Current Tax Year30651875CurrentTaxYear
Total123219246Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99270PublicSupportPercentage509
Prior Year Support Percentage0.99210PriorYearSupportPercentage
Investment Income Percentage0.00730InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00780PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis3110843OtherCostOrOtherBasis
Book Value3110843BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis29927558OtherCostOrOtherBasis
Depreciation8059356Depreciation
Book Value21868202BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings24979045TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
DescriptionRESTRICTED BOND RESERVESDescription
Book Value7878594BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Program Related7878594TotalOfBookValueProgramRelated

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
RESIDENT TRUST ACCOUNTS$51,869
INTERCOMPANY PAYABLES$33
FieldValueIRS element (for citing)
Total Of Amounts51902TotalOfAmounts
Total Revenue30688607TotalRevenue
Total Expenses29899740TotalExpenses
Excess Or Deficit For Year788867ExcessOrDeficitForYear
Net Unrealized GL On Investments167804NetUnrealizedGLOnInvestments
Other-$3,397OtherAmount
Total Adjustments164407TotalAdjustments
Excess Or Deficit Per FS953274ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt30873600TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments167804NetUnrealizedGainsInvestments
Other Revenues17189OtherRevenues
Revenue Not Rptd F990184993RevenueNotRptdF990
Revenue Subtotal30688607RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99030688607TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt29919800TotExpensesEtcAuditedFinclStmt
Other Expenses Included20756OtherExpensesIncluded
Expenses Not Rptd F99020756ExpensesNotRptdF990
Expenses Subtotal29899044ExpensesSubtotal
Other Expenses Not Included696OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt696ExpensesNotRptdOnFinStmt
Total Expenses Per Form99029899740TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:FOOTNOTE 1 TO THE FINANCIAL STATEMENTS STATES MANAGEMENT HAS REVIEWED ITS OPERATIONS FOR UNCERTAIN TAX POSITIONS AND HAS DETERMINED NO UNCERTAIN TAX POSITIONS EXIST.
PART X: RESIDENT TRUST ACCOUNTS BALANCE $54,425 CARRIAGE QUALITY INC MANAGEMENT AGENT PAYABLE $107,043 DUE TO THIRD PARTY PAYORS $31,166 PART XII LINE 2D ROUNDED FINANCIAL STATEMENT ADJUSTMENT -175 RENTAL EXPENSES -PG 9 LINE 6B 7,529 NET ADJUSTMENT - LINE 2D 7,354 PART XIII LINE 2D ROUNDEND FINANCIAL STATEMENT ADJUSTMENT -587 RENTAL EXPENSES - PG 9 LINE 6B 7,529 NET ADJUSTMENT 6,942

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY
39133785597710VJ842006-07-19330000DEBT PREVIOUSLY FINANCED FOR ACQUISITION OF FIVE NURSING HOME FACILITIES000
WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY
39133785597710VH922006-07-19345000DEBT PREVIOUSLY FINANCED FOR ACQUISITION OF FIVE NURSING HOME FACILITIES000
WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY
39133785597710VJ662003-07-192020000DEBT PREVIOUSLY FINANCED FOR ACQUISITION OF FIVE NURSING HOME FACILITIES000
WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY
39133785597710VJ742006-07-192655000DEBT PREVIOUSLY FINANCED FOR ACQUISITION OF FIVE NURSING HOME FACILITIES000

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Year Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
20060000
20060000
20060000
20060000

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00001
00001
00001
00001

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
000000
000000
000000
000000

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY
39133785597710VJ822006-07-197170000DEBT PREVIOUSLY FINANCED FOR ACQUISITION OF FIVE NURSING HOME FACILITIES000
WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY
39133785597710V4B12007-09-07585000ACQUISITION OF SIX ASSISTED LIVING FACILITIES LOCATED IN WISCONSIN000
WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY
39133785597710V4602007-09-171130000ACQUISITION OF SIX ASSISTED LIVING FACILITIES LOCATED IN WISCONSIN000
WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY
39133785597710V4H82007-09-173605000ACQUISITION OF SIX ASSISTED LIVING FACILITIES LOCATED IN WISCONSIN000

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Year Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
20060000
20070000
20070000
20070000

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00001
00001
00001
00001

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
000000
000000
000000
000000

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY
3913378559771044J42007-09-177935000ACQUISITION OF SIX ASSISTED LIVING FACILITIES LOCATED IN WISCONSIN000
WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY
391337855977108VD12010-08-01980000REFINANCE AND IMPROVEMENTS OF LIVIING FACILITIES000
WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY
39133785597710BVE92010-08-011275000REFINANCE AND IMPROVEMENTS OF LIVIING FACILITIES000
WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY
391337855977108BG42010-08-016910000REFINANCE AND IMPROVEMENTS OF LIVIING FACILITIES000

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Year Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindIssuance Costs From ProceedsIssuanceCostsFromProceeds
20070000
2010000033178
2010000042226
20100000226210

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 3THE ORGANIZATION HAS ENGAGED CARRIAGE HEALTHCARE INC. (CHC) TO PROVIDE MANAGEMENT SERVICES THROUGH JUNE 30, 2011. CHC IS AN INDEPENDENT "FOR PROFIT" ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11THE BOARD HAS DESIGNATED THE CHAIRMAN AND SECRETARY TO REVIEW AND SIGN THE 990 ON BEHALF OF THE BOARD. ALL BOARD MEMBERS RECEIVE A COPY OF FORM 990.
THE POLICY IS MONITORED THROUGH THE CORPORATE COMPLIANCE PROGRAM. REPORTS ARE PROVIDED TO THE BOARD ON AN ANNUAL BASIS.FORM 990, PART VI, SECTION B, LINE 12C
COMPENSATION AND MANAGEMENT COMPANY AGREEMENTS ARE REVIEW BY INDEPENDENT BOARD MEMBERS ON AN ANNUAL BASIS. COMPARABLE DATA IS OBTAINED IN ORDER TO ESTABLISH REASONABLE AMOUNTS.FORM 990, PART VI, SECTION B, LINE 15
THE ORGANIZATION WILL PROVIDE DOCUMENTS UPON WRITTEN REQUEST TO THE COMPANY.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 167,804. DEPRECIATION ADJUSTMENT -3,567. ROUNDING 170. TOTAL TO FORM 990, PART XI, LINE 5: 164,407.FORM 990, PART XI, LINE 5:
BOARD RESPONSIBILITYTHE ENTIRE BOARD REVIEWS AND HAS RESPONSIBILITY FOR THE FINANCIAL STATEMENTS. THIS POLICY IS UNCHANGED FROM PRIOR YEARS.FORM 990 - LINE 2C SCHEDULE XI

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1WELLINGTON HOMES OF WISCONSIN LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line113185 WEST GREEN MOUNTAIN DRIVEAddressLine1
CityLAKEWOODCity
StateCOState
ZIP Code80228ZIPCode
FieldValueIRS element (for citing)
EIN260564338EIN
Primary ActivitiesASSISTED LIVING FACILITYPrimaryActivities
Legal Domicile StateWILegalDomicileState
Total Income4990300TotalIncome
EOY Assets13785600EOYAssets
Direct Controlling Entity NAN/ADirectControllingEntityNA

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